For 7 -year-old Zachary Risotti, feeling safe and cared about is
a new experience.

At 2, Zachary was taken to the emergency room because of a suspicious
cigarette burn under his left eye. Six months later, he was back
in the hospital with a burn on his right forearm. Suspecting abuse,
the state Department of Social Services removed him from his home,
but he bounced around three foster homes before he was finally adopted
in July 2000.

By then, Zachary already bore psychological scars of child abuse.
At 3, he had the communication skills typical of a toddler half
his age. He avoided eye contact, fidgeted constantly and expressed
his frustration by sitting in a corner and crying.

But intensive mental health and support services as well as a loving
family have given Zachary a second lease on life. ''Today he's happy,
very sociable and doing well in school,'' said his adoptive mother,
Kathryn Risotti of Marlborough.

Until recently, mental health clinicians could only speculate on
the ways that abuse and neglect damage a child's developing brain.
But a series of ground-breaking studies in neuroscience conducted
over the last decade are allowing researchers to pinpoint the actual
changes in children's brains caused by traumatic experience.

These new neurobiological findings show that trauma - physical
abuse, sexual abuse and neglect - dramatically affects both the
structure and chemistry of the developing brain, thus causing the
behavioral and learning problems that plague about three-quarters
of the children mired in the child welfare system. But the good
news is that these brain changes aren't necessarily permanent. In
fact, timely interventions - as in the case of Zachary - can help
rewire the brain and put psychological development back on track.
As Department of Social Services Commissioner Harry Spence put it:
''Neuroscience has helped to clarify our mission. We must do more
than just protect children after the brain damage has been done.
We must also provide loving environments because they are fundamental
to healing on a physiological level.''

Dr. Martin Teicher, an associate professor of psychiatry at Harvard
and director of the Biopsychiatry Research Program at McLean Hospital
in Belmont, has been at the forefront of this new line of research.

In one of the first major studies in the field published in The
Journal of Neuropsychiatry and Clinical Neurosciences in 1993, Teicher
linked abuse to brain wave abnormalities. Reviewing the records
of 115 consecutive admissions to a child and adolescent psychiatric
hospital, Teicher found brain wave abnormalities in 54 percent of
patients with an abuse history, but in only 27 percent of nonabused
patients. And 72 percent of the patients in the sample with a history
of both physical and sexual abuse had these neurological abnormalities.

As a rule, Teicher said, the greater the severity of the abuse,
the greater the impact on brain function. And the relationship of
the perpetrator to the child also matters: ''Sex abuse by a family
member is worse than abuse by a priest or a baby-sitter.''

Several studies now document that abuse damages key brain structures
such as the cortex, which is associated with rational thinking,
and the hippocampus, which helps process memories and emotions.
Both brain regions are critical for learning.

In a study published in the same journal in 1998, Teicher and his
colleagues used brain scans to compare 15 child victims of severe
abuse with 15 healthy volunteers. The left cortex of the abused
group was underdeveloped. Likewise, studies by Dr. Douglas Bremner
of Yale and Dr. Murray Stein of the University of California at
San Diego have found that the left hippocampus is smaller in abuse
victims.

Abuse also damages the amygdala, an almond-shaped cluster of nuclei
located in the brain's emotional control center that enables us
to respond quickly to danger - say, to step out of the way of a
swerving car. But repeated abuse causes the amygdala to signal danger
even when there is no apparent threat.

Dr. Bruce Perry, a neuroscientist who heads the nonprofit research
center, the Child Trauma Academy in Houston, said: ''A maladaptive
amygdala makes an abused child recoil in fear at the drop of a hat.''

This negative impact on developing brain structures is associated
with changes in brain chemistry. Overwhelming stress early in life
also alters the production of both the stress-regulating hormone
cortisol and key neurotransmitters such as epinephrine, dopamine
and serotonin, the chemical messengers in the brain that affect
mood and behavior.

These biochemical imbalances can have profound implications. For
example, abuse typically lowers serotonin levels, leading to depression
and impulsive aggression.

Dr. Bessel van der Kolk, the internationally known expert on psychological
trauma who serves as Medical Director of the Trauma Center in Allston,
is now studying how treatment can undo these neurobiological effects.

One of 12 treatment sites across the country recently selected
to receive a grant under a new federal program called the Child
Traumatic Stress Initiative, the Trauma Center educates schools
and communities throughout northern New England on state-of-the-art
treatment methods for traumatized children.

Van der Kolk said he is convinced that Prozac-type drugs, which
affect the neurotransmitter serotonin, can often improve a child's
functioning or quality of life. But he insisted that medication
is only part of the answer. ''Positive experiences that contradict
a traumatized child's negative expectations are critical to helping
the brain to readjust itself. For example, just saying to a child
that you are sorry the event happened changes brain chemistry.''

Dr. Alexandra Cook, who directs Children's Services at the Trauma
Center, also stressed that interpersonal experiences such as psychotherapy
can change neurobiology. For instance, Cook began treating a girl
she calls ''Sally'' when she was 5, right after her father had been
sent to jail for sexually abusing her and the family had relocated
to Massachusetts. Sally was prone to temper tantrums, and she was
crying for three hours a day.

''I hypothesized that the abuse, plus the stress of testifying
at her father's trial and the move had led to a cascade of chemical
changes in her brain and body,'' Cook said. ''Her amygdala couldn't
stop firing.''

To stabilize Sally, Cook helped her find constructive ways to discharge
her overwhelming emotions. So, when Sally would run laps around
the table in her office, Cook did not discourage her. Cook then
suggested that Sally try ''messy painting,'' an activity involving
splattering water colors on paper. After about four months of weekly
sessions, Sally was much calmer and could move from stabilization
to memory processing, the next phase of therapy.

Cook said she believes that the therapy improved the circuitry
in Sally's brain because she never saw such acute distress again.

Some animal studies do show that new experiences can actually regenerate
brain cells, but the ''research on humans is not there yet,'' said
Dr. Glenn Saxe, chairman of the Department of Child Psychiatry at
the Boston University School of Medicine.

Unfortunately, traumatized children such as Zachary and Sally who
receive specialized treatment services remain the exception rather
than the rule. According to the US Department of Health and Human
Services, a million children are abused each year, and researchers
estimate that fewer than 10 percent are benefiting from appropriate
interventions.

''There is a huge disconnect between what science says we should
do and the services we are now providing for maltreated children,''
said Dr. Jack Shonkoff, dean of the Heller School at Brandeis University
and a co-author of a comprehensive recent study published by the
National Research Council and the Institute of Medicine called ''From
Neurons to Neighborhoods: The Science of Early Childhood Development.''

Yet, the window for psychobiological change never slams shut. The
new neuroscientific findings have upended the deterministic view
that brain development is essentially over by age 3. Although the
most rapid period of brain growth occurs during early childhood,
the brain continues to change throughout adulthood. But the more
time that elapses between the abuse and the onset of treatment,
the more entrenched are the neurological abnormalities.

''The brains of adult survivors are fragmented and resemble a hard
drive on a computer that has crashed,''

Strong Oak, codirector of the Survivors Project, a drop-in center
for adults in Greenfield, who runs psychoeducational groups on overcoming
the biological effects of trauma, said: ''The brains of adult survivors
are fragmented and resemble a hard drive on a computer that has
crashed.''

This story ran on page C1 of
the Boston Globe on 9/24/2002.
Š Copyright
2002 Globe Newspaper Company.